Brentwood Aesthetic and Family Dentists
Effective Date February 16, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.

CONTACT INFORMATION

For more information about our privacy practices, to discuss questions or concerns, or to get additional copies of this notice, please contact our office.

5123 Virginia Way St B12
Brentwood, TN 37027
615-221-8837
office@brentwoodfamilydentists.com

OUR LEGAL DUTY

We are required by law to protect the privacy of your protected health information (“medical information”). We are also required to send you this notice about our privacy practices, our legal duties, and your rights concerning your medical information.

We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect on the date set forth at the top of this page and will remain in effect unless we replace it.

We reserve the right at any time to change our privacy practices and the terms of this notice, provided such changes are permitted by applicable law. We reserve the right to make any change in our privacy practices and the new terms of our notice applicable to all medical information we maintain, including medical information we created or received before we made the change in practices.

We may amend the terms of this notice at any time. If we make a material change to our policy practices, we will provide you the revised notice. Any revised notice will be effective for all health information we maintain. The effective date of a revised notice will be noted. A copy of the current notice in effect will be available in our facility and on our website. You may request a copy of the current notice at any time.

We collect and maintain oral, written, and electronic information to administer our business and to provide products, services, and information of importance to our patients. We maintain physical, electronic, and procedural safeguards in the handling and maintenance of our patients’ medical information, in accordance with applicable state and federal standards, to protect against risks such as loss, destruction, and misuse.

USES AND DISCLOSURES OF YOUR MEDICAL INFORMATION

Treatment:
We may disclose your medical information, without your prior approval, to another dentist or healthcare provider working in our facility or otherwise providing you treatment for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, your health information may be disclosed to an oral surgeon to determine whether surgical intervention is needed.

Payment:
We provide dental services. Your medical information may be used to seek payment from your insurance plan or from you. For example, your insurance plan may request and receive information on dates that you received services at our facility to allow your employer to verify and process your insurance claim.

Health Care Operations:
We may use and disclose your medical information, without your prior approval, for health care operations. Health care operations include:
• healthcare quality assessment and improvement activities
• reviewing and evaluating dental care provider performance, qualifications and competence, health care training programs, provider accreditation, certification, licensing, and credentialing activities
• conducting or arranging for medical reviews, audits, and legal services, including fraud and abuse detection and prevention
• business planning, development, management, and general administration, including customer service, complaint resolutions, billing, de-identifying medical information, and creating limited data sets for health care operations, public health activities, and research

We may disclose your medical information to another dental or medical provider or to your health plan, subject to federal privacy protection laws, as long as the provider or plan has had a relationship with you and the medical information is for care quality assessment and improvement activities, competence and qualification evaluation, or fraud and abuse detection and prevention.

Your Authorization:
You (or your legal personal representative) may give us written authorization to use your medical information or to disclose it to anyone for any purpose. Once you give us authorization to release your medical information, we cannot guarantee that the person to whom the information is provided will not disclose that information.

You may revoke your written authorization at any time, except if we have already acted based on your authorization. Your revocation will not affect any use or disclosure permitted while it was in effect.

Unless you give us written authorization, we will not use or disclose your medical information for any purpose other than those described in this notice. We will obtain your authorization prior to using your medical information for marketing, fundraising, or commercial purposes. Once authorized, you may opt out of these communications at any time.

Family, Friends, and Others Involved in Your Care or Payment for Care:
We may disclose your medical information to a family member, friend, or any other person you involve in your care or payment for your health care. We will disclose only the medical information that is relevant to the person’s involvement.

We may use or disclose your name, location, and general condition to notify or assist an appropriate public or private agency to locate and notify a person responsible for your care in situations such as a medical emergency or disaster relief efforts.

We will provide you with an opportunity to object to these disclosures unless you are not present, are incapacitated, or it is an emergency or disaster relief situation. In those situations, we will use our professional judgment to determine whether disclosure is in your best interest.

Health-Related Products and Services:
We may use your medical information to communicate with you about health-related products, benefits, services, payment for those products and services, and treatment alternatives.

Reminders:
We may use or disclose medical information to send you reminders about your dental care, such as appointment reminders via U.S. Mail, email, and telephone. By providing your email address to us, you agree that you may receive reminders and breach notifications via email as an alternative to U.S. Mail.

It is the policy of our office to leave a message on any voicemail or answering machine attached to a number that you provide (home, cell, or work). If you prefer that we NOT leave a message, please let us know.

Plan Sponsors:
If your dental insurance coverage is through an employer-sponsored group dental plan, we may share summary health information with the plan sponsor.

Public Health and Benefit Activities:
We may use and disclose your medical information, without your permission, when required or authorized by law for:
• public health reporting
• averting a serious and imminent threat to health or safety
• health care oversight
• research
• court and administrative orders
• law enforcement
• coroners, medical examiners, funeral directors, and organ procurement organizations
• military and national security activities
• workers’ compensation claims

Special Protections for SUD Records:
Substance Use Disorder (SUD) treatment records have enhanced protections and cannot be used in legal proceedings without your consent or a court order.

If a use or disclosure described above is prohibited or limited by other laws, we will follow the more stringent law.

Business Associates:
We may disclose your medical information to business associates that perform functions or services on our behalf. They are required by contract to protect your information.

Data Breach Notification Purposes:
We may use your contact information to provide legally required notices of unauthorized acquisition, access, or disclosure.

Additional Restrictions on Use and Disclosure:
Certain federal and state laws may require special protections for highly confidential information, including:

  1. HIV/AIDS
  2. Mental health
  3. Genetic tests (GINA 2009)
  4. Alcohol and drug abuse
  5. Sexually transmitted diseases and reproductive health
  6. Child or adult abuse or neglect, including sexual assault

YOUR RIGHTS

  1. You have the right to see and get a copy of your health records.
  2. You have the right to amend your health information.
  3. You have the right to receive an accounting of disclosures.
  4. You are entitled to receive a Notice of Privacy Practices.
  5. You may decide if you want to give authorization before your information is used for marketing. We do not sell or disclose your information to outside firms.
  6. You have the right to receive your information confidentially and restrict communication methods.
  7. You have the right to restrict who receives your information.
  8. You have the right to request amendments to your records in writing.
  9. If you believe your rights are being denied, you may:
    a) File a complaint with your provider or insurer
    b) File a complaint with the U.S. Government
  10. Right to opt out of fundraising activities.

COMPLAINTS

If you believe we violated your privacy rights or disagree with a decision we made, you may contact our Privacy Officer to file a verbal or written complaint.

You may also submit a written complaint to:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, SW, Room 509F
Washington, DC 20201
Hotline: 1-800-368-1019

We support your right to privacy and will not retaliate if you file a complaint with us or the U.S. Department of Health and Human Services.

Return Home